Abstract
We present the case of a woman with bipolar I disorder with severe premenstrual mood instability, confusion, and psychosis resembling the clinical features of postpartum psychosis when estrogen levels are expected to be low, and hypomania when estrogen levels are expected to be elevated. While depressive symptoms across the menstrual cycle have been extensively documented in the literature, there is little information regarding manic and hypomanic symptoms. In addition, we describe the successful treatment of her menstrual-cycle related symptoms. Approaches to the management of menstrual psychosis have not been systematically studied, and clinical guidelines do not exist. Clinical experiences such as the one reported here, in which the clinical formulation of the patient was consistent with known neuroendocrine phenomena and in which the treatment approach was successful, are crucial to developing promising approaches that can be tested in controlled trials.
References
Brockington I (2011) Menstrual psychosis: a bipolar disorder with a link to the hypothalamus. Curr Psychiatry Rep 13:193–197
Deuchar N, Brockington I (1998) Puerperal and menstrual psychoses: the proposal of a unitary etiological hypothesis. J Psychosom Obstet Gynecol 19:104–110
Kulkarni J, Garland K, Scaffidi A et al (2006) A pilot study of hormone modulation as a new treatment for mania in women with bipolar affective disorder. Psychoneuroendocrinology 31:543–547
Kulkarni J, Gavrilidis E, Wang W et al (2015) Estradiol for treatment-resistant schizophrenia: a large-scale randomized-controlled trial in women of child-bearing age. Mol Psychiatry 20:695–702
Matsuoka K, Yasuno F, Inoue M et al (2014) Microstructural changes of the nucleus accumbens due to increase of estradiol level during menstrual cycle contribute to recurrent manic episodes—a single case study. Psychiatry Res Neuroimaging 221:149–154
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Susser, L.C., Hermann, A.D. Protection against hormone-mediated mood symptoms. Arch Womens Ment Health 20, 355–356 (2017). https://doi.org/10.1007/s00737-016-0702-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-016-0702-9